PIP (Dorsal, including fracture dislocation)
1-3 days s/p reduction: Patient is fitted with a dorsal blocking splint (DBS) at 30 degrees (up to 45 degrees if fracture present and there is severe edema). AROM is performed within the limits of the splint and instructed in exercises to be performed at home 6 times daily. Swelling is managed with coban wrapping.
10-14 days s/p reduction: Dynamic flexion splinting may be added if needed. Heat modalities in clinic may be added to decrease pain and increase tissue extensibility.
3 weeks s/p: PROM may be added to program with in the limits of the splint.
4 weeks s/p: DBS is increased 10 degrees (15 degrees if starting from 45). Exercises are unchanged.
5 weeks s/p: DBS is increased 10 degrees (15 degrees if starting from 45). Exercises are unchanged.
6 weeks s/p: DBS is discontinued and unrestricted A/PROM is initiated.
7 weeks s/p: Dynamic PIP extension splinting may be used if needed. Light progressive strengthening initiated as tolerated by patient.
Shoulder (anterior) dislocation:
1-2 days s/p reduction: Icing, sling immobilization when not exercising, active scapular exercises, AROM to elbow, forearm, wrist and hand, Pendulum exercises if OK’d by referring M.D.
3 days s/p: Heat modalities may be added to help with pain and increase soft tissue extensibility.
2-3 weeks s/p: Sling is gradually weaned, AA/PROM is initiated to shoulder except combined external rotation and abduction. Pendulum exercises with light weight to increase glenohumeral distraction.
4-6 weeks s/p: Progressive strengthening is added as pain subsides and AROM improves. Strengthening of internal rotators, and adductors are emphasized to help prevent redislocation.
